title: The best salvage operation method after total necrosis of a free jejunal graft? Transfer of a second free jejunal graft.
abstract: OBJECTIVE
  Transfer of a free jejunal graft is the first choice for reconstruction after total laryngopharyngo-oesophagectomy (TPLE). After total necrosis of a jejunal graft, possible salvage procedures include temporary external fistula formation and transfer of a second free jejunal graft. The present study determines the most appropriate salvage method.
  
  
  METHODS
  We have transferred over 600 vascularised free jejunal grafts during the past 22 years for reconstruction, immediately after TPLE, either at the National Cancer Center Hospital or at Okayama University Hospital. A second free jejunal graft was transferred to treat the first vascularised free jejunal graft that had undergone total necrosis in five of these patients. We reviewed the total number of operations, the interval between the operation and the start of oral feeding, the outcomes and the follow-up periods of the five patients.
  
  
  RESULTS
  Each of the second free jejunal grafts was positioned without complications. All patients resumed postoperative oral food intake after a mean interval of 20.4 days. Four of the five patients remain free of tumour recurrence and in good health.
  
  
  CONCLUSIONS
  Our results suggest that the best salvage method after total necrosis of an initial free jejunal graft is to transfer a second jejunal graft. Therefore, the severity of contamination of the neck due to jejunal graft necrosis must be minimised at re-operation to transfer a second free jejunal graft using microvascular anastomosis.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. sonoda@md.okayama-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Onoda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yamada
authors.forename: Narushi
authors.initials: N
authors.lastname: Sugiyama
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
mesh_terms: D000368:Aged; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010611:Pharyngectomy; D012086:Reoperation; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply / Q000473:pathology*; D013927:Thrombosis / Q000150:complications